The most up to date evidence shows that women in the Isle of Man need full spectrum, accessible abortion services, free of any age or timing restrictions, conclude researchers in an editorial, published online in BMJ Sexual and Reproductive Health.

Their conclusions come as the Isle of Man parliament–The Tynwald–holds the first debate on new draft abortion legislation this week (Tuesday 23 January) to allow Manx women to have greater access to abortion services through the island's healthcare system.

The Isle of Man has one of the most restrictive abortion laws of any European jurisdiction, and until 1995, abortion on the island was governed by a law dating back to 1872, which banned it.

The 1995 Termination of Pregnancy Act still imposed strict eligibility criteria, and abortion performed outside of these circumstances remains a criminal offence, punishable by up to two years in prison.

Most Manx women who want an abortion must either therefore travel to England, Wales or mainland Europe for the procedure. Or they can order abortion pills (mifespristone or mispostol) online for use at home with telemedicine assistance: although safe and effective, this option still falls outside Manx law.

The proposed new legislation would allow abortion on request up to 14 weeks, or up to 24 weeks in the case of serious health concerns for the mother or fetus. And it would decriminalise abortion.

The most up to date evidence shows that these proposals are vital if the needs of most Manx women seeking abortion are to be addressed, say the researchers.

But the evidence also shows that few women in the Isle of Man request an abortion following rape or as a result of abnormalities in the developing fetus.

"Thus a narrowly construed policy reform to increase access to abortion in only these circumstances would do very little to address the needs of the vast majority of Manx women who require access to abortion care," they caution.

And while most Manx women receive the abortion care they need before 13 weeks, according to the evidence, this suggests that while the 14 week limit for abortion on request in the proposals reflects the current situation, "it is highly unlikely to be necessary, since most women are below or well below this threshold when accessing care in any case, they add.

Figures from the Department of Health and Social Care in England show that over the past decade more than 1000 Manx women used abortion services in England and Wales, but that they are increasingly less likely to take this option.

On the other hand, data from Women on Web (WoW) show that more of them are availing themselves of the telemedicine service offered by WoW: the number of requests quadrupled from 12 to 54 between 2010–the first year of data collection–and 2016.

These data also show that among those requesting this service:

· There is a wide mix of ages and circumstances

· Just over half (54%) were using contraception when they became pregnant

· More than three quarters (77%) were less than 7 weeks' pregnant; the rest were under 9

· The reasons for the request were many (284) and varied

· One in three felt they just couldn't cope with a child

· More than a quarter felt they couldn't afford to raise a child

· Around one in five felt they were too young or wanted to finish school

The data on women seeking an abortion outside the island showed similar patterns.

"These data demonstrate the urgency and importance of reforming current abortion law in the Isle of Man. While two main safe and effective options are available to Manx women, both place significant burdens on Manx women and are likely to result in delays accessing care ," write the researchers, drawing comparisons with the plight of women seeking abortions in Northern Ireland and the Republic of Ireland.

Decriminalisation is essential, to bring abortion "out of the shadows and into the mainstream, and to reduce the stigma criminalisation can engender," they insist.

And they conclude: "The impending reform on the Isle of Man is a valuable opportunity for evidence-based debate and to design a law that ensures full-spectrum, accessible, affordable, and acceptable reproductive healthcare for Manx women."

BMJ Sexual & Reproductive Health is one of more than 60 specialist journals published by BMJ. The title is co-owned with the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists.